Microsoft PowerPoint - ASANCOA 07 Disaster FINAL

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					Disaster Preparation & Response

      Older Adults and Disaster: Assets and
                   Challenges

                        Lisa Patton, Ph.D.
         SAMHSA Older Americans Substance Abuse & Mental Health
                      Technical Assistance Center

                   ASA-NCOA Joint Conference
                        March 7, 2007
                         Chicago, IL
U.S. Baby Boomers II

‘Baby Boomers’ have started to retire and
  will increase in the next ten years

  Enormous pressure on retirement systems,
  health care facilities, and other services

  Major implications for substance abuse and
  mental health prevention and treatment




                                               2
          Depression and Anxiety

One in five older adults has a significant mental
disorder
   Primary psychiatric illness: 16 percent
   Dementia complicated by psychiatric symptoms: 3 percent
Depression affects 3-7 percent
Anxiety affects 11 percent
   Frequent comorbidity among anxiety, depression,
   and physical illness.




                                                             3
                  Consequences
An estimated one in five older Americans (19%) may be
affected by combined difficulties with alcohol and
medication misuse.
Aging-related changes make older adults more
vulnerable to adverse alcohol effects
  More impairment at a given blood alcohol content (BAC) level
  Interactive effects of alcohol, chronic illness, and medication
Older adults are three times
as likely to develop a mental disorder with a lifetime
diagnosis of alcohol abuse.


                                                                    4
    Behavioral Health Resources

Current systems are strained

Many clinicians are uncomfortable working with
older adults

Aging workforce

Low workforce recruitment rates


                                                 5
                  Rise in Disasters

In 2003, 254 million people were affected by natural
hazards— nearly three times as many as in 1990.
Intensity and number of
disasters continue to increase.
   Kashmir earthquake in 2005
   killed over 90,000 people.
   Tsunamis in South and
   Southeast Asia in 2004 killed
   over 186,000 people.            HURRICANE RITA EVACUATION:
                                   Nursing home and hospital patients are
                                   placed in baggage carriers before
                                   boarding Sept. 23 at the Port Arthur,
                                   Texas, airport. (Houston Chronicle)
                                                                       6
Special Needs of Older Adults in Disasters

  The aging process puts older adults at
  increased risk
    Physiologically
    Psychologically
    Socially

  Planning often overlooks these needs




                                             7
     Planning Needs of Older Adults

    Communication
    Literacy
    Mobility
    Visual
    Hearing
    Cognitive
    Cultural


What are special needs
in disaster preparation and response?

                                        8
               Phases of Disaster

Older adults experience accumulated loss and
trauma during disasters
    Loss of loved ones
    Loss of possessions
    collected over a lifetime
    Needs change during
    the phases of disaster
       Pre-disaster
       Post-Disaster                       SAMHSA, 2004




                                                          9
              Post-Disaster Recovery




Goal of returning                                         How does grief or
to pre-disaster                                           loss affect one’s
level of functioning                                      ability to cope in
                                                          the aftermath of
                                                          disaster?



                       A resident of New Orleans at the
                       front of his home following
                       Hurricane Katrina. FEMA photo.
                                                                               10
 Grief Reaction Appears to be Universal

Disbelief
     Initial reaction of grief as one come to terms with
     actual loss
Questioning
     Seeking reasons
     Making the events believable by knowing its cause
Anger
     Non-directional and emotional
     Semi-violent
Guilt/Blame
     Seeking the source of responsibility for the disaster
     Focused on self, others, or God/fate

                                                             11
Main Components of Grief Reaction

Desperation
     Avoiding eye contact
     Overwhelmed with
     resignation/dismay            Older adults may be
     Sense of hopelessness         overwhelmed with the
                                   process of completing
Powerlessness
                                   application paperwork
     Sense of loss of ability to
                                   to obtain financial
     impact life events
                                   assistance.
     Increased emotional
     response
     Multiple feelings of fear,
     hostility, love, guilt/hate


                                                      12
   Special Populations to Consider


Dementia/Alzheimer’s       Older adults are
                           particularly vulnerable
Mobility issues
                           because of increased time
Significant physical       since formal education,
disabilities               decreased sensory abilities
Non-native language        (i.e., vision and hearing),
                           and declining cognitive
speakers
                           functions.
Caregivers who are older
adults


                                                   13
                Cultural Sensitivity

  Being aware of the various cultural groups affected by the
  disaster. This includes:
     Ethnic & racial groups hardest hit by the disaster
     Language barriers
     Suspicion of the government
  Be sensitive to:
     Dominant language/English fluency
     Immigration experience and status
     Family values
     Cultural values and traditions
How is disaster managed by different cultures?
                                                               14
Older Adults are Assets in Disaster

Pre-disaster
  Identification of special needs older adults
  Inform needs of older adults population
  Community outreach
  Increase public awareness
  Create a culture of preparedness (i.e. Florida’s Elderly Ready
  communities)
Post-disaster
  Model resiliency and successful coping
  Support other older adults and identify those needing
  services


                                                               15
        Older Adults as Partners

Planning Phase:
   Identify areas in which many older adults reside
   (high-rise communities, assisted living centers,
   etc)
   Specify additional planning considerations (i.e.,
   the need for additional evacuation time)
   Ensure older adult community “buy-in” and trust
   prior to a disaster




                                                       16
       Older Adults as Partners II

During the Disaster:
  Older adults may assist in “talking” friends into
  evacuating
  Share knowledge of the needs of their neighbors
  (i.e., if a neighbor requires oxygen or if a neighbor
  does not have access to communication channels
  (telephone, television, etc)
  Provide companionship during an evacuation




                                                          17
      Older Adults as Partners III

Response Phase:
  Lead support groups for younger populations and
  share their resilience because they have survived
  similar experiences
  Serve as community leaders
  Share their knowledge of community resources
  Provide linkages to community and churches




                                                      18
                  Partnerships

Form relationships with key service systems that work
with diverse older adult populations, including:
     Aging service providers (i.e. U.S. Area Agencies on Aging)
     Senior centers and congregate living
     Independent living centers
     Personal care providers (i.e. primary care physicians)
     Veteran organizations (i.e. Veterans Administration)
     Homeless service providers
     Pharmacies
     Volunteer organizations
Aging experts need to have a seat at the disaster
planning and response table
                                                                  19
         For More Information


        Lisa Patton, Ph.D., Project Director



SAMHSA Older Americans Substance Abuse & Mental
      Health Technical Assistance Center
       OlderAmericansTAC@westat.com
               1-888-281-8010




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                                   Sources I

Center for Mental Health Services, Substance Abuse and Mental Health Services
    Administration. Psychosocial Issues for Older Adults in Disasters. U.S. Department of
    Health and Human Services. SMA 99-3323.
Centers for Disease Control and Prevention. (2006). Healthy Aging for Older Adults.
    Retrieved June 2006 at http://www.cdc.gov/aging/
Cutilli, C. (2005). Health literacy: What you need to know. Orthopedic Nursing, 24(3), 227-
      233.
DESA, United Nations. (2002). Report of the Second World Assembly on Ageing.
   Retrieved 2006 from United Nations at http://www.un.org/esa/socdev/ageing/waa
Department of Economic and Social Affairs, Economic Division, United Nations. (2005).
    Living Arrangements of Older Persons Around the World. Retrieved June 2006 at
    http://www.un.org/esa/population/publications/livingarrangement/chapter2.pdf
Florida Department of Elder Affairs. (2006). Department of Elder Affairs Master Plan:
      Disaster Preparedness Workgroup.
Florida Department of Elder Affairs. (2006). Disaster Preparedness Guide for Elders. Vol.
      15, No. 4.
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                                Sources II
Nielsen-Bohlman, L., Panzer, A.M., & Kindig, D.A. (Eds). (2004). Health literacy: A
     prescription to end confusion. Committee on Health Literacy, Board on Neuroscience
     and Behavioral Health, Institute of Medicine of the National Academies. Washington,
     DC: The National Academies Press.
Office of the Special Envoy for Tsunami Recovery, United Nations. (2006). Focus on
     Recovery: The Human Toll. Retrieved June 2006 at
     http://www.tsunamispecialenvoy.org/country/humantoll.asp
Population Division, Department of Economic and Social Affairs, United Nations
    Secretariat. (2002). World Population Ageing 1950-2050. New York, NY.
Population Division, Department of Economic and Social Affairs, United Nations
     Secretariat. (1998). World Population Prospects, The 1998 Revision, Volume II: Sex
     and Age.
U.S. Census Bureau. (2004). We the People: Aging in the United States. Eds Gist, Y., &
     Hetzel, L.Washington, DC.
U.S. Department of Homeland Security. (2006). Special Needs Items for Seniors.
     Retrieved June 2006 from Ready.Gov at
     http://www.ready.gov/america/special_needs_items.html


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                                Sources III
V.R. Pine. (1996) “Social Psychological Aspects of Disaster Death”. In Living with Crisis
   After Sudden Loss, K.J. Doka, and J.D. Gordon, (Eds.)
World Health Organization. (2003). The World Health Report 2003 – Shaping the Future.
   Retrieved 2006 from World Health Organization at http://www.who.int/whr/2003/en/




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